Medical Questions

I have answered all question in this form honestly and I am aware that if I have answered yes to any of the questions I will need to consult my GP before commencing an exercise program if I am affected by any of the questions mentioned in this form now or at a later date I agree to inform my personal trainer or instructor on any changes in health or fitness.

If yes to any of the below, please elaborate in the text field below.

Please indicate if you currently or have ever suffered from any of the following conditions:

1) Heart problems: [Provide details below if applicable]

2) Circulatory problems

3) Blood pressure problems

4) Joint or movement problems

5) Feel dizzy or imbalanced during exercise

6) Currently pregnant or recently given birth

Health History

Please indicate if you currently receive medical care or if any of the following affect you:

7) Back or spinal pain: [Provide details below if applicable]

8) Headaches or migraines

9) Recently had surgery

10) Currently being prescribed medication

11) Recently finished a course of medication

12) Diabetes

13) Asthma or breathing problems

Is there any other reason that you believe may prevent you from taking part in any regular activity?